Inspection on 22/09/08 for Glebe House

This inspection was carried out on 22nd September 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Glebe House 23/06/08

Glebe House 28/09/07

Glebe House 10/04/07

Glebe House 03/10/06

Glebe House 25/10/05

Glebe House 23/11/04

Glebe House 19/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Glebe House The Broadway Laleham Staines Middlesex TW18 1SB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 2 2 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Glebe House The Broadway Laleham Staines Middlesex TW18 1SB 01784465273 01784459390 helen@surreyresthomesltd.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Surrey Rest Homes Ltd The registered provider is responsible for running the service Name of registered manager (if applicable) vacant post Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category sensory impairment Additional conditions: The maximum number of service users to be accommodated is 24. The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age- not falling within any other category - (OP) Dementia- over 65 years of age - 3 (DE(E)) Sensory impairment- over the age of 65 years - 2 (SI(E)) Date of last inspection Care Homes for Older People Page 4 of 28 Over 65 3 24 2 0 0 0 Brief description of the care home Glebe House is a large detached property located in the village of Laleham, Middlesex. The home is owned by Surrey Rest Homes Ltd and provides accommodation and care for up to 24 older people, 3 of whom may have dementia and two of whom may have a sensory impairment. The accommodation is arranged over three floors, with a passenger lift and a stair lift available to access the first floor. The second floor is reached by stairs. There are 22 single occupancy rooms, 19 of which have en-suite facilities, and one double room. Those rooms without en-suite facilities are located close to toilets and/or bathrooms. The communal areas include a large lounge leading onto a conservatory, a dining room and another conservatory at the far end of the building. There is a large, enclosed, garden with a patio to the rear of the property and parking for several cars to the front. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an unannounced ‘Key Inspection’. Mrs L Garrett, Regulation Inspector, carried out the inspection. The unregistered manager of another care home in the group represented the service. For the purposes of this report she will be referred to as the person in charge. The newly appointed manager was there for some of the morning session but had left by lunchtime. The service manager for the group arrived at the home in time for the feed back session. The inspector arrived at the service at 10.10 and was in the home for seven hours. It was a thorough look at how well the home is doing. It took into account information provided by the home and any information that CSCI has received about the service since the last inspection in September 2007. Care Homes for Older People Page 6 of 28 The inspector spent time talking with some of the people living at the home in order to seek their views about the home and the care they receive. The home supplied CSCI with an AQAA (Annual Quality Assurance Assessment). This document was used to assist with the inspection The inspector looked at how well the service was meeting the key national minimum standards and complying with the regulations and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the home’s Statement of Purpose and Service User Guide, care plans, daily records and risk assessments, medication procedures, staff files, some training records, and the home’s safeguarding and complaints policies and procedures. The home had a pharmacy inspection in June 2008 and the requirements made at that time have all now been met. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 28 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service only move into the home following an assessment of their needs and are satisfied that their needs can be met. Evidence: The person in charge told us that the home has not been admitting new people to the home recently. There has been a voluntary cessation of admissions until a new manager had been appointed. Following a recent meeting the person in charge said that this voluntary arrangement had now been lifted and that they would now be accepting new admissions to the home. Pre-admission assessments are carried out prior to admission to the home and the person in charge said that these will be carried out by the person in charge at the home and the newly appointed operations manager, who is the clinical lead for the company. Care Homes for Older People Page 11 of 28 Evidence: Three care plans were sampled. The pre-admission assessment had been completed but it had not been signed or dated by the staff carrying out the assessment. A relative was spoken to on the day who confirmed that their relative had been seen by a member of staff prior to admission and there was an opportunity to visit the home prior to admission. The service user guide and statement of purpose was sampled and these are made available for all new admissions to the home. It contained the current management arrangements for the home and the person in charge said they are regularly reviewed and updated. The home does not have intermediate beds. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans in the home reflect the care needs of people using the service and contained evidence that healthcare professionals opinions and advice are sought and acted upon. Evidence: Three individual care plans were sampled. These were found to contain all of the necessary information that allows staff to care adequately for the people in their care. All the risk assessments had been completed and had been signed, dated and agreed by the people using the service. One care plan sampled did not contain any signatures.The completed AQAA gave very little information about the care plans or documentation used within the home. It was explained to the person in charge that the AQAAs need to be more detailed that the one presented for this inspection. The person in charge stated that all people who use the service are registered with several general practitioners (GP) but they are all from the same surgery. On the day of inspection it was explained that one particular resident was unwell and that the GP Care Homes for Older People Page 13 of 28 Evidence: had been called. The GP did visit during the morning and the daughter was able to speak with her about her relative. The person in charge said they also received good support from other healthcare professionals. They included the district nurse, chiropodist, opticians and dentist. The home also has access to clinical nurse specialists and a recent visitor to the home had been the diabetic nurse. During the inspection the paramedics were called to assist a person who had fallen. The nurse in charge said that they were a good support to the them and on this occasion there was no need to take the person to hospital.The person in charge also said that they have access to the local falls clinic where people at risk of falling or who hve fallen can be assessed and advice then given on their future management. The home had a pharmacy inspection in June 2008. This was a through look at the medication practices within the home. The person in charge stated that the senior carer is responsible for the ordering of the medicines and that they now have a controlled drugs cupboard. Part of the lunchtime medicine round was observed. This was completed by a senior carer and the medicines were administered appropriately with the correct checks made and the records updated following administration. Time was given for people to take their medicines and they were treated with respect. During the course of the inspection staff were observed interacting with the people using the service and spending time in the lounge or their bedroom talking and assisting them when needed. Staff were seen to knock on peoples doors prior to entering and addressing them by their preferred name. A requirement was made following the last inspection for the files of people using the service to be kept secure. They are now stored in the office in a locked cabinet. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities at the home are limited and do not always meet the expectations of the people living there. Evidence: It was observed that during the day no activities were available for people living at the home. The person in charge said that they have no activity organiser and any activity that takes place is organised by the staff. This means that people are not offered sufficient opportunities for activities, based on their individual needs and choices, and as a result they are not able to maximise their independence. One person told us that they do not join in much activity and another said they could not remember when there was something to do at the home. No programme of activity was available but the person in charge said staff do organise quizzes, bingo and word games. During the last inspection in September 2007 it was reported that activities within the home had improved but there was no evidence of sustained improvement during this inspection and a requirement will be made at the end of the report. Care Homes for Older People Page 15 of 28 Evidence: The person in charge said that visitors to the home are always encouraged and on the day of inspection this was observed. One visitor said that the staff make her feel welcome at any time. the person in charge said that there is a church service every month and at two people who use the service attend church every Sunday. Staff at the home enable the people who use the service to make choices in their daily life. Staff were observed to be offering them the opportunity to visit the bathroom prior to lunch and asking if they would like assistance to the dining room. Staff told us that the people are offered choices about the clothes to wear and if they prefer male or female carers to assist them. During this inspection we did not look at the kitchens in any depth. The person in charge said that an environmental health officer had visited in July 2008. Requirements were made at the time of that visit and the person in charge said that they had all been complied with. Lunch time was observed and the service of meals. Tables were laid with tablecloths and napkins.The carer was offering the people using the service a choice of drinks but these were poured into coloured plastic cups. We also observed that the crockery, that had recently been delivered to the home, was also plastic. The person in charge said this was to save on costs as crockery and glasses were often broken on the hard flooring in the dining room. Feed back was given to the service manager at the end of the inspection and he said that he would speak to the provider about replacing the plastic equipment with glass and china. There was a choice of menu on the day and the person in charge said that the cook has a likes and dislikes list in the kitchen for all of the people who use the service. The alternative meal on the day was steak pie. The presentation of this meal was poor as the pie had been placed on the plate upside down with mashed potato and gravy available but no vegetables. The person in charge said this was not usual. Residents are consulted about the menus and this was seen on the notice board. food is discussed at resident meetings and suggestions are made at that time. The person in charge said that menu decisions for the home are taken at head office and the manager attends these meetings. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their complaints are listened to and that they are protected from abuse. Evidence: The manger stated that all people using the service and their relatives have access to the home’s complaints policy. The policy contained the old address for CSCI and the person in charge was asked to change the details. Staff spoken to was aware of the new address and this was displayed in the office. Some of the information contained in the policy was three years old and it will be a requirement that the complaints policy to be reviewed and updated. The person in charge keeps a complaints log for the home. This was viewed and all complaints had been resolved within the homes timescales. The home has the local authority’s safeguarding procedures 2008 and the home’s local policy matches these procedures. Staff spoken to had knowledge of the steps to follow in the event of witnessing any abusive behavior. The person in charge stated that all training is delivered by another home manager in the group. It is recommended that the senior staff at the home enroll on the local authoritys safeguarding training to ensure that their knowledge is current. Three staff files were sampled and they confirmed that they had received training in safeguarding. Care Homes for Older People Page 17 of 28 Evidence: The home has recently attended a meeting following a safeguarding adult alert at the home and this has now been concluded. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables people who use the service to live in a safe, well-maintained and comfortable environment. Evidence: The home has recently completed a refurbishment programme. During the last inspection in September 2007 decorators were on the premises finishing the painting of the hall and stairs. This has been completed and the AQAA states two new bathrooms have also been added. These bathrooms were viewed but it was noticed that they are still not completed and therefore not used. The windows have no blinds in place and the person in charge said they are still waiting for these two areas to be completed. The people who use the service all have their own rooms and the rooms that were visited by us had been personalised to reflect that persons taste and individuality. The atmosphere at the home was calm and quiet with some of the people using the service observed sitting in the lounge or conservatory and some remaining in their bedroom. The person in charge said that the staff take it in turns to put the laundry into the washing machines and the night staff do all the ironing. The laundry floor has been recovered following the requirement made during the last inspection. Staff have received Care Homes for Older People Page 19 of 28 Evidence: infection control training and records confirmed this. The AQAA advised that during the last twelve months the home has been decorated throughout and their plan for improvement during the next twelve months is to finish the refurbishment. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained and skilled and in sufficient numbers to support the people using the service. Recruitment practices at the home protect the people living there. Evidence: The home had a relaxed atmosphere and staff were observed to undertake their tasks in a quiet and orderly manner. We observed staff interactions with people using the service all of which were professional and supportive. The staff in the home during the day were relaxed and calm with the people using the service.The staff rotas were seen and the person in charge said that dependency levels are completed every month and then the staff levels can be decided. The rota demonstrated that there is a senior carer on each shift and the manager is always supernumerary. The person in charge said that they try not to use agency staff and that they have recently recruited new staff. On the day of the inspection we received many compliments about the staff one said the staff are very good here, they are always kind to me. A relative said that her mother was looked after very well by the staff. National vocational qualification (NVQ) training continues to take place for the staff. Care Homes for Older People Page 21 of 28 Evidence: This needs to continue to ensure that all staff eventually have this qualification. It will be a recommendation at the end of the report for the staff team to access the NVQ training. Three staff recruitment folders were sampled and these contained most of the information required to employ staff that protect the people living at the home. Of the three folders sampled two had no explanation for the gaps in their employment and therefore this will be a requirement at the end of the report. The staff folders that were sampled demonstrated that training takes place at the home as certificates were in place. Talking to staff they all confirmed the training that they had received and this included safeguarding adults, manual handling, fire awareness and first aid. The person in charge said that another home manager from the group undertakes some of the training at the home. Staff also have access to some training videos but these sessions are not supervised by a trainer. There was no training programme in the home to indicate what training had taken place for all staff and what is planned for the year. The person in charge said that some certificates were not in the folders of the staff as they had not arrived at the home following the training session. It is recommended that a programme of proposed training for the year be kept at the home. The records sampled showed that induction training takes place. The newly appointed manager for the home had just completed the first two weeks of his induction with the manager from another home working along side him. Staff told us that they had received induction when they were first recruited. The induction programme used by the home is linked to a national induction programme. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements at the home have been improved which will benefit the people who use the service. Evidence: The homes provider has recently employed a new manager. He is currently undertaking his induction assisted by a manager from another home, this person has been referred to as the person in charge for the purposes of this report. The person in charge has been at the home for the past three months covering while Surrey Rest Homes appointed a new manager . The proposed manager has a NVQ level 4 qualification but will still need to achieve his registered mangers award. He attended the first two hours of this inspection before leaving the home for a prior appointment. The home has now been without a registered manager for over a year. The service manager that attended the inspection for feed back stated it was Surrey Rest Homes intention to register this manager following induction. Care Homes for Older People Page 23 of 28 Evidence: The person in charge told us that they have recently posted surveys to the relatives or representatives and health care professionals. Some had already been returned and the results were shown to us. Most were very complimentary about the care and support their relative receives. All made comment about the quality of the activity programme rating this as poor. This has been addressed earlier in the report and a requirement has been made. Regulation 26 visits take place every month. The service manager stated that he had carried most of these out at the home. They were not available on the day of the visit but we were told these would be sent from head office to the home for filing. The person in charge and the service manager were also told about the poor quality of the completed AQAA. It had been completed by the person in charge who had only recently transferred on a temporary basis to the home. It had been sent to head office for checking and completing by the new service manager but this had not been done. We spoke with the service manager and explained that the home had now missed the opportunity to tell the commission all about the good things that the home does and the improvements that they are planning for the next year. Assurances were given by the person in charge that the future AQAAs would be checked and fully completed before returning them next year. The person in charge told us that families can give money to the home for safekeeping and to pay any bills they may have. Each person has has a sheet with a record of payments and withdrawals. the person in charge said that all receipts are kept and the hairdresser also keeps her own records. Two of these records were sampled and they were correct. Following the last inspection in September 2007 a number of health and safety issues were identified. The worn carpets have all been replaced and the fire extinguishers were not being used to prop open doors. Regular fire alarm tests take place and the staff also have training in fire drills. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 16 22 The policies and procedures relating to complaints to be reviewed and updated All people using the service should have current policies and procedures available to them so that in the event that they need to complain current information is available to them. 22/10/2008 2 29 19 All recruitment folders to be reviewed to ensure that all gaps in the employment history have been explored. This will ensure the safety and well being of the people who use the service. 22/11/2008 3 33 26 Records of the Regualtion 26 22/10/2008 unannounced visits to the home to be kept available at the home. To ensure that the people who use the service benefit from good quality assurance procedures. Page 26 of 28 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 10 It is recommended that the plastic cups and plastic crockery is replaced to ensure the dignity of the people using the service. It is recommended that the senior staff at the home enrolls on the local authoritys safeguarding adults training to ensure their knowledge is current. This information to then be passed on to other members of the team. It is recommended that a training programme is kept at the home to demonstrate the proposed training for the year, the dates that this will take place and the members of staff that have attended. 2 18 3 30 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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